Diabetes Mellitus Type II - 2 CEs

Author: Kristi Hudson RN MSN CCRN

Written: January 10, 2006

Updated: September 28, 2009

Course Description

This course is designed to give an overview of the care and management of the patient with Diabetes Type II (adult onset). Focus will be placed on differentiating Diabetes Type I from Type II and discussing the pathophysiology associated with Diabetes Type II. Causes, diagnosis and risk factors of Diabetes Type II as well as clinical manifestations, medical treatment and pharmaceutical options will be presented. Complications of Diabetes Type II, patient education and NANDA nursing diagnoses for patient with Diabetes Type II will be the final focus of this course.

Course Objectives

Upon completion of this course the student will be able to:

• Differentiate Diabetes Type I and Type II.
• Discuss the pathophysiology associated with Diabetes Type II.
• Describe the causes and the diagnosis for Diabetes Type II.
• Discuss the risk factors associated with Diabetes Type II.
• List 3 clinical manifestations of Diabetes Type II.
• Explain current medical treatment options for Diabetes Type II.
• Differentiate between the different types of insulin.
• State 3 potential complications of Diabetes Type II.
• Describe important patient education for Diabetes Type II.
• List three appropriate nursing diagnoses for patients with Diabetes Type II.

Differentiating Diabetes Mellitus Type I and Type II:

Type I Diabetes (juvenile onset) – although the cause is unknown, Type I Diabetes accounts for approximately 10% of all cases of diabetes in the western world. Type I Diabetes is thought to be an autoimmune mediated disease that results from a failure of the body to produce insulin (a necessary hormone that allows the bodies cells to open allowing for the glucose to enter the cell).

Type II Diabetes (adult onset) – this type of diabetes is much more common and results from insulin resistance, deficiency or the inability to secrete adequate amounts of insulin.

Pathophysiology of Diabetes Type II:

Cellular resistance (beta cells) to the effects of insulin is the major factor in Type II Diabetes. Properly functioning insulin is essential to the body for the following:

• Processing carbohydrates, fats and proteins.
• Reducing blood glucose levels by allowing glucose to enter muscle cells.
• Stimulating the conversion of glucose to glycogen (glycogensis).
• Inhibiting the release of stored glucose from the liver (glycognolysis).
• Slowing the breakdown of fat to triglycerides, free fatty acids and ketones.
• Stimulating fat storage.

When the body’s insulin is not functioning properly (due to resistance, lack of secretion or deficiency), diagnostic testing often confirms that the patient has Diabetes (Type II).

Risk Factor/Causes of Diabetes Type II:

Diabetes Type II is believed to have a strong genetic link in the western world, however; there are other environmental and health risks associated with this disease. Although obesity is thought to be the number one cause of Diabetes Type II, the following are also thought to be contributing factors:

• Hypertension
• High blood triglyceride levels
• Gestational diabetes (birthing children greater then 9 lbs also)
• High fat diets
• Increased alcohol intake
• Sedentary lifestyle (lack of exercise)
• Certain racial groups are at increased risk (African Americans, Native Americans, Hispanic and Japanese Americans)
• Increasing age (risk significantly rises after age 45)

Diagnosis of Diabetes Type II:

The diagnosis of Diabetes Type II is similar to that of Type I. The most common symptoms include polydipsia, polyuria, and polyphagia. When the above symptoms are present, the following testing can be done to confirm Diabetes Type II:

• Oral Glucose Tolerance Test (OGTT): This test involves drawing a fasting blood glucose level, then having the patient drink a sweet drink that consists of 75 grams of sugar and then re-drawing a blood glucose level 2 hours later. If the blood sugar is greater to or equal to 200 mg/dl, the person is considered to positive for diabetes (this test is often repeated for confirmation).
• Glycosylated Hemoglobin or Hemoglobin A1c (more commonly used): This lab test measures how high a person’s blood glucose level has been over the past 120 days (or the lifespan of a red blood cell). Because excess glucose attaches to red blood cells and stays attached for the life of the red blood cell, a better average of a person’s glucose can be measured. Glycosylated hemoglobin values that are greater then 6.1% are highly suggestive of diabetes. Once diabetes has been confirmed it is this test that is often run (usually every 3 to 6 months) to determine if diabetic treatment regimens have been successful.

Additional Clinical Manifestations of Diabetes Type II:

In addition to the classic 3 P’s (polydipsia, polyuria, polyphagia); other clinical manifestations that patients may present with include:

• Initial weight loss
• Hyperglycemia on fasting blood glucose lab draws
• Recurring Infection
• Poor wound healing
• Fatigue
• Visual disturbances

Medical Treatment:

The goal of medical treatment is to return the patient to as near a euglycemic state as possible and correct any related metabolic disorders. If diet and exercise are not adequate to control a persons blood sugar levels; patients will often require oral hypoglycemic agents or in some cases subcutaneous insulin therapy to control their blood sugar. The following chart describes common oral hypoglycemic agents and their action.

When oral hypoglycemic agents at maximum doses are unable to maintain a blood glucose level less then 180 mg/dl; subcutaneous insulin therapy may be required. The following chart is a description of different types of insulin that may be prescribed including the onset, peak and duration of the medication.

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